Standing Committee E
Wednesday 4 June 2003
[Mr. Win Griffiths in the Chair]
The Chairman: I have one housekeeping point before we start. Please feel free to take your jackets off. It is technically quite difficult to open the windows, but we are trying to make sure that the services provide some cold air to counter any hot air that may be raised in the Committee this morning.
The Commission for Healthcare Audit and Inspection
Chris Grayling (Epsom and Ewell): I beg to move amendment No. 460, in
clause 36, page 13, line 27, after 'the', insert 'Independent'.
The Chairman: With this it will be convenient to discuss the following amendments: No. 461, in
clause 36, page 13, line 28, leave out 'CHAI' and insert 'ICHAI'.
No. 368, in
No. 462, in
clause 36, page 13, line 29, leave out 'CHAI' and insert 'ICHAI'.
No. 463, in
clause 37, page 13, line 31, after 'the', insert 'Independent'.
No. 464, in
clause 37, page 13, line 32, leave out 'CSCI' and insert 'ICSCI'.
No. 369, in
No. 465, in
clause 37, page 13, line 33, leave out 'CSCI' and insert 'ICSCI'.
Chris Grayling: Good morning, Mr. Griffiths. We now move on to the audit and inspection structure that the Government aim to establishthe Commission for Healthcare Audit and Inspection. However, in the amendments that have been selected this morning, we hope to make a small modification by adding the word ''Independent'' at the beginning of the titles of the Commission for Healthcare Audit and Inspection and its counterpart for social services.
The tone of the debate that is likely to follow, not just on this set of amendmentsI know that Liberal Democrat Members are minded to go in the same directionbut on a number of other issues that arise on this part of the Bill will show how important it is
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that the body established to inspect health care should be independent. If my hon. Friend the Member for West Chelmsford (Mr. Burns) is fortunate enough to catch your eye in this debate, Mr. Griffiths, he wishes to address the same point in relation to the Commission for Social Care Inspection, or the ICSCI, as we hope it will be. The bodies must be truly independent of the Government, truly able to set out standards for health care, to play devil's advocate to the Government and the health care providers and to provide a quality of health care that goes far beyond the rather constrained nature of the present system, driven as it is to far too great an extent by the targets culture established by the Government, which is doing so much damage to the provision of health care.
Too much of this part of the Bill still leaves reference points, controls and influences inappropriately in the Secretary of State's hands. In the run-up to this debate a number of reports in the media, which access the behind-the-scenes discussions taking place in the Government and in health care about the Bill, have called into question the Government's motives for creating the inspectorates, asking whether they are likely to be as independent as the initial rhetoric has made out.
For example, on 7 March the Daily Mail reported:
''Alan Milburn was accused last night of trying to gag a new NHS watchdog before it even starts work. The Health Secretary has insisted that the Commission for Healthcare Audit and Inspection . . . will be independent and have real teeth. But a draft version of the Bill to create the watchdog, which will take over the Audit Commission's role in the NHS next year, reveals that ministers want to keep it on a tight leash.''
The Times reported:
''A senior Whitehall source said . . . that a draft of the legislation showed the Department of Health was seeking to water down previous guarantees of the commission's independence. The source claimed that ministers were seeking 'powers of intervention and initiation' to direct inquiries, while also limiting its right to publish findings without prior departmental clearance.''
Although many of the measures in the Bill establish CHAI as an independent body, members of the Committee will see as we go through the debate a number of areas where that independence is compromised. This symbolic set of amendments at the start of the debate on CHAI is designed to reinforce the organisation's independence.
We are adopting this approach for a number of reasons. The first is the flawed nature of the star rating system, which is perpetuated in the Bill. That system is not a truly independent assessment of the quality of health care. We stress in our amendments that the commission must be independentindependent in its very name through to the way in which it is established, the details of the way in which it works and the parameters within which it works alongside the Government. The star rating system does not reflect an organisation that can provide a true and independent assessment of the quality of health care. The most obvious reason for that is that the star ratings do not reflect clinical outcomes: they are fundamentally about administrative matters. They measure such things as financial management, hospital cleanliness and the length of time that patients wait for treatment, all of which are important, but they do not measure
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clinical outcomes; they do not assess whether people get better. What more important measurement could there be of the effectiveness of our health care system than the quality of the clinical outcomes that it delivers?
We believe that a truly independent inspectorate would ensure a much broader reflection of the strengths and weaknesses of hospitals, not simply in the way in which they are run or meet objectives, but through the quality of the health care that they deliver. We want an independent inspectorate to pursue that dimension of its work, and not simply the management framework, as occurs in the current star rating structure. Once again, it is essential that the word ''independent'' be added to strengthen the organisation and set the tone from the start of the debate by saying that these bodies will be free of the Government.
In far too many areas the focus on Government targets is reflected in the way in which the Commission for Health Improvement works. When we debate clause 46 we will see how that clause perpetuates that link and the Government's ability to use their political objectives to shape the inspectorate's work and how that link distorts the work of our health care system.
Too many examples today point to a lack of independence and the fact that CHIthe Commission for Healthcare Audit and Inspection, as it will becomeis not independent of government. They show that in too much of its work it is a tool of government. We have seen some clear examples of the way in which the targets culture distorts clinical decision making.
The Chairman: Order. I want to clarify a point. The amendments relate to the body's independence, but you have jumped one step ahead. Indeed, you have said that the issue of targets and how the service will respond will come up again. That is not strictly part of this debate. Therefore, while it is fair to refer to it, I do not want an in-depth analysis of it: that can come later.
Chris Grayling: I am grateful for your clarification, Mr. Griffiths. The point, as I am sure you will appreciate
The Chairman: I can see the point that you are making. I do not want a lot of detail on it.
Chris Grayling: We want to see an inspectorate that is truly independent. My hon. Friend the Member for West Chelmsford will address in the same context the issue of the parallel bodies that the Bill establishes. The Liberal Democrat amendments, with which I have some sympathy, would also strengthen the perceptions and nature of the inspectorate's independence from Government.
As we debate this part of the Bill, we will pursue a system of inspection that is independent, takes a dispassionate view of the quality and delivery of health care in this country and does not allow political priorities to interfere with the decision making, quality and nature of assessment and the reference points that
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it uses. We want a system that truly reflects whether our health service is doing a decent job and making us better in a way that minimises the impact of illness on quality of life. Our intention is to set a clear tone for the debate and place on public record where we believe that the organisation should sit, what powers it should have, and how we can ensure a clear and pronounced separation between it and the Government.
The organisation should also monitor the Government. As the Government will continue to play a significant role in the management of health care in this country, why should they be free from the scrutiny of the watchdog? Why should the watchdog not be able to tell the Secretary of State when his Department is not working correctly and impeding clinical work across the NHS? To do that, the watchdog must be independent and have the power to act according its principles. It should have the necessary professional expertise and resources and, ultimately, it must be a free organisation that can make a real difference to health care.
That is what we shall argue for as we debate this part of the Bill, and I hope that the Government will be willing to have a reasoned and sensible debate about how we can strengthen the organisation and give it the teeth that it will need to make a real difference to health care.